Shivam Singh, Farhad R. Udwadia, and J. Wesley Boyd
It is said that no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens, but its lowest ones.
Conditions inside Indian prisons are poor at best and abhorrent at worst. Many of these prisons are overcrowded breeding grounds for HIV and TB and torture is commonly practised.1 This happens despite Indian law that guarantees those who are incarcerated are protected from torture and they also have a right to healthcare.2 But the vast majority of incarcerated individuals in India lack access to adequate–if any–medical or mental health care and face myriad other injustices. Given this reality, it is not surprising that mental health disorders are dramatically higher amongst Indian prisoners than the rest of the population.3
Torture contributes to prisoners’ mental health burdens and mortality.4 They are often tortured soon after being placed in police custody: one study found that “99 percent of deaths in police custody can be ascribed to torture and occur within 48 hours of the victims being taken into custody.”5 Prisoners on death row are particularly likely to be tortured, including experiences like “being hung by wires, being forced to drink urine, being placed on a slab of ice, having a leg broken, forced anal penetration and more.”6 Overall, torture in Indian prisons is rampant, extreme, and exacts a huge toll on the health and well-being of incarcerated individuals.
Despite this impact on health and the need for reforms, Indian physicians remain largely silent on the issue. We believe that the silence from the medical community is not borne out of callousness, but instead out of a lack of knowledge about what occurs inside their prisons. We think this because we conducted a survey of Indian medical students and found that they knew very little about health-related human rights violations in Indian prisons, as well as the ethical norms and legal rights granted to prisoners.7
A final year class of medical students were asked about their knowledge and attitudes towards prisoner health and human rights. Ninety-two percent reported that they received less than one hour of education regarding prisoner health and access to health care, but encouragingly 86% believed that medical students ought to receive more education on the subject.
A lack of human rights training in medical school left these students ignorant of prisoners’ rights: for example, 55% agreed that solitary confinement was an acceptable form of punishment, even though it is widely considered to be torture. Given this response, it is not surprising that 30% were unsure about the acceptability of using coercive traumatic tactics such as beating and waterboarding that also constitute torture by internationally accepted standards. Of even greater concern, 41% felt these practices were acceptable. In addition, 38% agreed that it was permissible for physicians to participate in capital punishment.
Even though some might assert that prisoners deserve harsh punishments, it is worth noting that nearly two-thirds of the prison population in India have not been convicted of any crimes, but instead are awaiting trial.8 Many of these “under-trial” prisoners are poor, uneducated, and have been charged with only minor violations of the law, but have poor access to legal or financial resources.9 So not only is it possible that they are not guilty of any crimes, the reality is that they likely had no effective legal representation to prove their innocence.
Irrespective of guilt or innocence, most of those who are incarcerated will eventually take their mental health and disease burdens back into their communities and health care systems. Given this reality, one might expect the Indian medical community to be more vocal about the atrocities Indian prisoners suffer.
The practices that have become the daily norm inside Indian prisons flout both Indian and international law. Ethical and societal issues aside, prisoners are legally protected by the Indian constitution and are entitled to the same fundamental rights around healthcare as everybody else.10
Graduating physicians from Indian medical schools are unaware of the health-related human rights violations and torture occurring inside Indian prisons. This contributes to their silence and lack of advocacy for prisoners’ rights. Human rights training is needed urgently to fully inform these future physicians about these legal and ethical violations. Doctors are a powerful lobbying group, and with a strong unified voice they could bring about reforms for the vulnerable individuals inside India’s prison walls.
Shivam Singh, MBE, is a bioethicist and graduate of Harvard Medical School Center for Bioethics, Boston, Massachusetts, USA. Email: firstname.lastname@example.org
Farhad R. Udwadia, MBE, is a bioethicist, HMS Center for Bioethics, and medical student, University of British Columbia, Vancouver, British Columbia, Canada.
J. Wesley Boyd, MD, PhD, is a faculty member in the HMS Center for Bioethics and a professor of psychiatry and medical ethics at Baylor College of Medicine, Houston, Texas, USA.
1 PTI. “India: overcrowding prisons a violation of human rights, says Supreme Court.” The Hindu (Chennai, India) May 13, 2018. Available at: https://www.thehindu.com/news/national/overcrowded-prison-involves-violation-of-human-rights-says-worried-supreme-court/article23871465.ece; K. Dolan and S. Larney. “HIV in Indian prisons: Risk behaviour, prevalence, prevention & treatment.” Indian Journal of Medical Research 132, no. 6 (2010): pp. 696-700; B. M. Prasad, B. Thapa, S. Singh Chadha, A. Das, E. Ramachandra Babu, S. Mohanty, S. Pandurangan, and J. Tonsing. “Status of Tuberculosis services in Indian Prisons.” International Journal of Infectious Diseases 56 (2017): pp. 117-121. Available at https://doi.org/10.1016/j.ijid.2017.01.035; S. K. Goyal, P. Singh, P. D. Gargi, S. Goyal, and A. Garg, “Psychiatric morbidity in prisoners.” Indian Journal of Psychiatry 53, no. 3 (2011): pp. 253-257. Available at: https://doi.org/10.4103/0019-5545.86819; Death Penalty Research Project, Project 39A. Death Penalty India Report Summary. Death Penalty Research Project. May 6, 2016. Available at: https://www.project39a.com/dpir.
2 M. B. Lokur, “Re: Inhuman Conditions in 1382 Prisons… vs State of Assam on 13 December, 2018.” Supreme Court of India. December 13, 2018. Available at: https://indiankanoon.org/doc/143664436/; Sunil Batra v. Delhi Administration, 2 SCR 557 (1980). Supreme Court of India. https://indiankanoon.org/doc/778810/.
3 Goyal (see note 1).
4 C. De, A. C. Williams, and J. van der Merwe. “The psychological impact of torture.” British Journal of Pain 7, no. 2 (2013): pp. 101-106. Available at https://doi.org/10.1177/2049463713483596
5 E. Randolph, “Human rights report says 14,000 Indian prison deaths in a decade.” The National (Abu Dhabi, UAE) November 23, 2011. Available at https://www.thenationalnews.com/world/asia/human-rights-report-says-14-000-indian-prison-deaths-in-a-decade-1.441995
6 Death Penalty Research Project, Project 39A (see note 1).
7 U. Singh and S. Boyd, “The Role of Medical Personnel in Improving Prisoner Rights and Health in India”. Harvard Medical School Bioethics Journal. April 1st, 2021. Available at https://bioethics.hms.harvard.edu/journal/prisoner-rights
8 Government of India; Ministry of Home Affairs. Prison Statistics India 2016; Executive Summary. New Delhi, India: National Crime Records Bureau, updated May 12, 2019. http://ncrb.gov.in/sites/default/files/Executive%20Summary-2016.pdf.
10 R. Jain, “Article 21 of the Constitution of India – Right to Life and Personal Liberty.” Lawctopus (Chandigarh, India) November 13, 2015. Available at www.lawctopus.com/academike/article-21-of-the-constitution-of-india-right-to-life-and-personal-liberty/#_edn81; Parmanand Katara v. Union Of India & Ors, 3 SCR 997 (1989). Supreme Court of India. https://indiankanoon.org/doc/498126/.